POS0376 THE ROLE OF ELECTRONIC CONSULTATION IN THE EARLY DIAGNOSIS OF INFLAMMATORY ARTHROPATHIES IN A THIRD LEVEL HOSPITAL
Authors: D. V. Mendoza Mendoza, D. Ruiz-Montesinos, V. Moreira Navarrete, J. J. Pérez Venegas
Journal: Annals of the Rheumatic Diseases (2022)

Background The relevance of early diagnosis in rheumatic inflammatory diseases is well known. Electronic consultation (e-Consults) is a tool for communication between primary health care (PHC) and hospital care (HC) physicians in order to present the cases of patients. It has proven to resolve cases without on-site consultations and to facilitate quick access to conventional consultations. Objectives To evaluate whether e-Consults is an effective tool in the early diagnosis of inflammatory arthropathies To evaluate whether the clinical suspicion of the rheumatologist correspond to the final diagnosis. Methods Retrospective, observational study of all e-Consults carried out during 2021 in the hospital area Virgen Macarena . All e-Consults were carried out by means of a computer program as a clinical extension of the research project E-Hermes for the implementation of e-Consults. The analysis focused on those e-Consults in which the rheumatologist suspected rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondylarthritis (SpA) in comparison with the final diagnosis. The on-site consultations and waiting time for appointments were also analyzed. Results During 2021, the number of e-Consults received was 733. Inflammatory arthropathy was suspected in 54 (7.4%). RA was suspected in 55.9% of the cases, PsA in 17.6% and SpA in 26.5% of the cases. 67.6% of the patients were women with an average age of 53.15 (± 17.06). 87.3% were recalled for an on-site consultation. Of these, 76.5% were given a preferential appointment and 11.8% were given a regular appointment. The waiting time for the preferential appointment was 18.5 days on average and 39 days for the regular appointment. 73.7% of the patients with suspected RA were women with an average age of 55.16 years (± 16.8). The reasons for consultation were: joint swelling (89.5%), polyarthralgia (5.3%) and hand pain (5.3%). The diagnosis of RA was confirmed in 47.4% of the suspected cases and only 27.7% showed no inflammatory joint pathology. 83.3% of the suspected PsA cases were women with an average age of 53 years (± 12.6). Joint swelling was the most frequent reason for consultation (50%) followed by polyarthralgia, lumbar back pain and hand pain (16.7%, respectively). The diagnosis of PsA was confirmed in 33.3% of the suspected cases. 55.6% of the patients with suspected SpA were men with an average age of 49 years (± 20.8). The most frequent reasons for consultation were: joint swelling (44.4%) and lumbar back pain (33%). The suspected diagnosis of SpA was confirmed in consultation in 44.4% of the patients and only 33.3% of the suspected cases showed no inflammatory pathology. After all 733 e-Consults performed in 2021, 14 patients (2%) were diagnosed with RA, 5 (0.7%) were diagnosed with PsA and y 6 (0.9%) with SpA, which means a 3.5% diagnosis of inflammatory arthropathy by means of e-Consults. The hospital area Virgen Macarena serves 481,296 inhabitants. Considering that the incidence per 100,000 patients/year is 8.3 for RA, 3.6 for PsA and 7.2 for SpA 1-2 , the number of new cases expected in our area are as follows: 40 for RA, 17 for PsA and 5 for SpA. The proportion of cases diagnosed by TC were 36% for AR, 27.7% for PsA and 18.5% for SpA, corresponding to the reference population. Conclusion The suspected diagnosis of the rheumatologist in the e-Consults was confirmed for inflammatory joint pathologies in almost half of the cases. E-Consults is a useful tool to identify inflammatory joint processes that need evaluation in an on-site consultation. E-Consults is an efficient method for the early detection of high-impact rheumatic diseases, facilitating quick access to those patients and minimizing diagnostic time. References [1]M.J. García de Yébenes et al. Rheumatoid arthritis: Epidemiology and societal and healthcare costs. Reumatol Clin Supl. 2018;14(2):3-6 [2]Munoz-Fernandez S et al. Early spondyloarthritis: results from the pilot registry ESPIDEP. Clinical and experimental rheumatology. 2010;28(4):498-503 Disclosure of Interests None declared